Stockport Metropolitan Borough Council

Stockport Prevention Hub

Briefly describe the initiative/ project/service; please include your aims and objectives

Introduction

Stockport Council’s overall approach to Prevention and Early Help centres on increasing the resilience of individuals and communities and their potential to help themselves and each other, supported by better online content and growing community assets; by a planned prioritisation of resources and within the context of improving the health and wellbeing of residents and reducing inequalities. We believe that Stockport Council’s approach to commissioning Early Help and Prevention services represents an innovative approach to providing timely and effective services for people at the point of need. The aims and objectives are summarised below:

Aims
– To identify and support vulnerable people with a range of needs
– Provide effective interventions earlier to stop problems from emerging in the first place, or, if issues have arisen, to help people to address them
– To prevent, reduce and delay the need for interventions from Adult Social Care, Stockport Family and the wider health, homelessness and criminal justice systems
– To improve access and referral arrangements to ensure that residents and professionals have timely and responsive access to information, advice and guidance and a range of support services

Objectives
Evaluate previous contracts to inform the recommission of the range of early help and prevention services

– Complete a Discovery phase to obtain feedback and understand gaps in provision from stakeholders and people with lived experience, to shape the specifications and recommission as a whole
– Analyse data, including the JSNA, to map previous, current and future demand
– Agree the financial envelope for each service being recommissioned
– Complete the procurement process, adopting a negotiated tender approach.

In September 2021, the Council went out to tender for a range of Prevention and Early Help Services. This involved recommissioning existing provision funded by Public Health, Stockport CCG, Adult Social Care and Children’s Services. Previously many of these services had been commissioned independently but we brought them together, ensuring a strong common vision, approach and identity linked to prevention and early help. The recommission is built on the success of the previous alliance contracting approach, which involved multiple providers delivering on individual contracts, resulting in the development of strong and mature relationships, partnerships and collaboration. We wanted to embed the learning from this and consider what we could do differently to improve this even further. There were eight lots in total, with an overall total contract value of £4,458,841 per year. The start date for these contracts was 1st April ‘22 and the length is five years, with the option to extend all these contracts by a further two years until March 2029.

Each service was developed following a review of evidence, best practice, and consultation, and built on the success of previous contracts and learning from the pandemic. Commissioners from different work areas worked closely together to share learning and alongside STAR procurement colleagues determined the most appropriate commissioning model, including using an open negotiated procedure to better refine requirements as well as capitalise on market expertise and innovation.

This approach allowed for flexibility and an ability to co-produce solutions and not be fettered by overly prescriptive specifications. A discovery phase prior to the tender ensured that commissioners, stakeholders and people with lived experience were able to offer their feedback on the previous commission and this feedback informed and shaped the new Early Help and Prevention offer. The following link provides more information on the Discovery phase: Stockport Support Services Part 1:
Discovery | Digital Stockport
The tender lots comprised of:
· Lot 1 Adult Substance Misuse Service
· Lot 2 Smoking Cessation, Tier 2 Adult Weight Management, Family Weight Management
· Lot 3 Stockport Support Hub and Your Support – a central hub for the Early Help and Prevention services and a boroughwide service
· Lot 4 Community Support – Connecting people to community activities, groups, peer support, learning and volunteering opportunities
· Lot 5 Community Transport – ran by volunteer drivers, this service supports people to get to appointments and activities
· Lot 6 Home Support – provides practical support, helping people to live safely and independently in their own home for as long as possible
· Lot 7 Carers Support – supporting unpaid carers who care for people who have an illness, disability, or addiction issues
· Lot 8 Domestic Abuse support – supporting people who are affected by domestic abuse and those who are worried about their own behaviour.

For this nomination we will be focusing on the introduction of Stockport Support Hub and the new model of service delivery for lots 3 – 8. A new model of service delivery.

What are the key achievements?

The main achievements of this commission can be summarised as follows:
– Improved referral processes
– Shared IT systems
– Improved access to services for residents and professionals
– Reduced waiting times
– Greater clarity on individual service offers
– Improvements to services
– Improved communications strategy
– Improved referral processes and shared IT systems

One of the main achievements of the new model of delivery is improved referral processes. The previous provision relied on direct referrals to individual services, with providers having no prior knowledge of referrals that may have been made into other services. This may have resulted in a duplication of resources. At the heart of the new model is the use of a shared IT system Charity Log, which all the providers have signed up to. Stockport Support Hub use portals within the Charity Log system to direct people to the Early Help and Prevention service they require. All the providers have equal access to referral information, including risk and previous presentations. This helps to build a picture of the support required. Improved access to services for residents and professionals One front door into services has many benefits for residents and professionals alike.

The vision of Stockport Support Hub becoming ‘the place to go’ to obtain information and advice on support services in Stockport is already being realised after just eight months of the service being in place, which is evident from the summary of statistics below:

-Total number of referrals into Stockport Support Hub since 1st April ‘22 – 3663
– Total number of referral sources – 118
– A total of 2167 pieces of advice have been given to 1106 people. The breakdown for advice given is Economic (61%), Health and Wellbeing (21%), Housing (10%), Social (6%), and Education, Skills, and Training (2%)
– A total of 1283 signposting’s have been made to 172 unique organisations
– A total of 1194 referrals have been made to 66 organisations.
– Reduced waiting times

Lessons were learnt from the previous commission, where services which were preventative in nature had become silted up, with long waiting lists of several months for some services. With the new model, referrals are triaged on the same day and are prioritised according to need and risk. Information, advice and guidance is provided by the triage team at Stockport Support Hub within a day or two and waiting times for referrals into the range of Early Help and Prevention services are currently less than a month.

Monthly case review meetings are held between the largest support service ‘Your Support’ and Adult Social Care to discuss an exit strategy for people who have been with the service for a few months. This has improved move on arrangements for people and ensured that the service is focused on Early Help and Prevention rather than longer term case management, something which had been an issue with the previous commission.
Greater clarity on individual service offers From a commissioning perspective, a number of changes were made to the specifications of two of the larger contracts to remove duplication and create better clarity on the service offers. This has meant that the community support element, which existed across two services previously, has now been merged into one service and is delivered by one provider instead of two.

The feedback from the providers has been that this was an entirely positive development as there was clear overlap and resources were not targeted as effectively as they could be previously. In summary, this means that the largest support service ‘Your Support’ can now focus on a coordinated package of support delivered by dedicated keyworkers and the ‘Community Support’ service focuses on linking people into the community offer.
Improvements to services. The recommission has also seen improvements to the service offers due to changes in the specifications and contract values. For example, the Home Support service had previously provided some support to people who hoard and/or have cluttered properties, but there were limitations to the offer.

Data and stakeholder feedback confirmed that the need for this specialist support had increased. As such, the requirement for a specialist hoarding/decluttering service was written into the specification for this contract. The provider is building on their experience in this area to expand the offer to more people and they have embedded the ‘8 Step Plan’ promoted by Hoarding Disorders UK to inform their approach to the support they provide to people in this situation. Improved communications strategy Feedback during the Discovery phase related to the need for better and more coordinated communications in relation to the Early Help and Prevention offer. People with lived experience commented that they were confused about the range of services and how to access them. Providers had their own individual websites and leaflets and this added to the Hub.

How Innovative is your initiative?

The Early Help and Prevention recommission reflects the Council’s vision and commitment to provide high quality and timely services to ensure that primarily people receive the support they need, when they need it, but also to prevent the likelihood of more formal or statutory interventions. The creation of a central hub was an innovative approach, which could easily be replicated in other local authority areas. This central hub has created an infrastructure which is likely to be developed and expanded upon further in the future. Stockport Support Hub has also been able to support cost of living initiatives such as Pension Credit take up and the promotion of money advice toolkits to people who access the service. The provider of this service has also successfully secured Greater Manchester funding for a pilot to work with offenders, which required a central hub approach as part of the specification.

The new Community Support service is a positive example of innovation and is aligned to the Council’s vision in relation to the development of a ‘One Neighbourhood Model’. Maximising community assets for the benefit of all Stockport residents not only ensures that informal support options and networks exist to promote inclusion and reduce social isolation, but also that the community and residents support themselves in a sustainable way. This approach reduces the reliance on formal support services so that this resource can be protected for people who are most in need. The model of ‘step up’ and ‘step down’ into the Community Support service is central to this model and innovative in its approach. From a commissioning perspective, translating the vision into reality was of slight concern as it was unclear whether the community offer would be enough for some people.

However, the risk has paid off as the model is working exactly as expected. A total of 429 referrals have been made from Stockport Support Hub to the Community Support service since 1st April ‘22. The decision to co-locate the Domestic Abuse Support service within Stockport Support Hub has also paid dividends and was an innovative approach. This offer provides early help to people affected by domestic abuse and will escalate referrals to higher level services such as IDVA support and refuge accommodation where this is an identified need. This coordinated approach addresses the issues in relation to victims struggling to access the support they need as quickly as possible, as highlighted on the Safe Lives website: How long do people live with domestic abuse, and when do they get help to stop it?

As with all changes to service delivery models and services, there was an element of risk involved in the recommission. Whilst the service providers and staff working in the services recognised the benefits of the new models described in the specifications, there were some concerns about how this would work in reality. During the mobilisation phase, monthly all provider meetings have been held in addition to regular contract monitoring meetings with the individual providers and the feedback from both could not have been more positive. Providers feel the new model is working much better; that there is greater clarity on the commissioner expectations of the support service offers; more collaborative working and that residents are benefiting from this greatly. Building on the success of the monthly all provider meetings during the mobilisation phase, the development of a wider Prevention Forum is a key priority for 2023.

Finally, learning from the Covid19 pandemic was built into the specifications for the recommission to ensure that this learning was embedded into service delivery. Providers have innovatively developed their online and digital offers to ensure that their services cater for people who prefer this to a face-to-face support option. This has extended further into the building and office space; a key development has been that services are more community based rather than having an office in the centre of Stockport, meeting people where they are rather than them having to travel to receive a service.

What are the key learning points?

The development of a central hub for Early Help and Prevention services is a model that could easily be replicated in other areas. One front door has improved the way that referrals are triaged and processed and has removed the likelihood of duplication. The importance of developing a shared IT system is a key learning point and providers are recognising the benefits of this. This is not something that was built into the specifications, but it very quickly became apparent that this was needed in order to process referrals effectively. The built-in portal in Charity Log has enabled referrals to be shared between all the providers, which has created efficiencies and more secure data sharing. It took some time to develop the portals with the IT supplier, so a learning point here is that it would be better to work on a shared IT system prior to new services going live.

Listening to feedback from stakeholders and people with lived experience prior to tendering is also a key learning point, which has informed every step of the recommission. This feedback has shaped the new model of delivery and the content of the specifications for each service. This feedback also identified the need for a robust communication strategy, something which was lacking with the previous commission, when even after several years of the contract being in place, professionals and service users were unclear of the range of services available, the referral routes and outcomes achieved for the people they referred. Involving a wide range of stakeholders in the planning and delivery of the tender ensured that the strategic objectives of all partners were achieved and reflected in the tender documentation.

People with lived experience were also involved in the planning and tender, resulting in rich feedback which genuinely shaped the new model of delivery to ensure that the services are accessible and inclusive to all and delivering the support that people feel they need. Perhaps one of the biggest challenges related to the volume of work involved in such a large tender, with eight services being recommissioned and a new model of delivery, at points the timescales felt challenging. The importance of a Discovery phase cannot be underestimated. This dedicated time to review the previous contracts, the policy and strategic direction and to obtain meaningful stakeholder and service user feedback was necessary to inform every aspect of the recommission. We utilised support from our design team to arrange the feedback sessions which was positive, the team used resources such as Miro boards to visualise the feedback and interactive engagement methods, so that the process was engaging and inclusive. Incorporating all of this feedback into the specifications took time and with hindsight, a longer lead in period prior to the tender going live would have been beneficial.

Another key learning point in the development of the new model is allowing the new offer and providers time to mobilise and embed these services. The support of commissioners during the mobilisation phase has been an important part of this, with regular contact and meetings with providers to work through any initial challenges and teething problems. Listening to providers and monitoring every aspect of delivery was crucial to the success of the recommission, along with an ability to think creatively and work in an agile way in order to overcome any barriers to successful delivery. Whilst some general KPIs were incorporated into the specifications, a learning point is that commissioners should not confirm the detailed longer term KPIs until later in the mobilisation phase. The reason for this is that outcomes may change based upon how the new offer is shaped and new systems may be introduced. For example, commissioners and providers have recognised the benefits of a shared wellbeing tool available in the Charity Log system called WEMWBS, so will be looking to incorporate this within the KPIs for each service.

Additional Comments

The recommission of Stockport Council’s Early Help and Prevention services was an ambitious tender and a positive example of joint commissioning across a number of departments. The collaboration between commissioners, providers, stakeholders and people with lived experience has been central to the success of the tender. The learning is also being embedded into future recommissions and best practice is being shared with other local authorities and across Greater Manchester.